Objectives: This study sought to describe our institutional experience of repeated percutaneous stellate ganglion blockade (R-SGB) as a treatment option for drug-refractory electrical storm in patients with nonischemic cardiomyopathy (NICM). Methods: This prospective observational study included 8 consecutive NICM patients who had drug-refractory electrical storm and underwent R-SGB between June 1, 2021 and January 31, 2022. Lidocaine (5 ml, 1%) was injected in the vicinity of the left stellate ganglion under the guidance of ultrasound, once per day for 7 days. Data including clinical characteristics, immediate and long-term outcomes, and procedure related complications were collected. Results: The mean age was (51.5±13.6) years. All patients were male. 5 patients were diagnosed as dilated cardiomyopathy, 2 patients as arrhythmogenic right ventricular cardiomyopathy and 1 patient as hypertrophic cardiomyopathy. The left ventricular ejection fraction was 37.8%±6.6%. After the treatment of R-SGB, 6 (75%) patients were free of electrical storm. 24 hours Holter monitoring showed significant reduction in ventricular tachycardia (VT) episodes from 43.0 (13.3, 276.3) to 1.0 (0.3, 34.0) on the first day following R-SGB (P<0.05) and 0.5 (0.0, 19.3) after whole R-SGB process (P<0.05). There were no procedure-related major complications. The mean follow-up was (4.8±1.1) months, and the median time of recurrent VT was 2 months. Conclusion: Minimally invasive R-SGB is a safe and effective method to treat electrical storm in patients with NICM.
Humans ; Male ; Adult ; Middle Aged ; Aged ; Female ; Stroke Volume ; Stellate Ganglion/surgery* ; Ventricular Function, Left ; Cardiomyopathies/complications* ; Tachycardia, Ventricular/therapy* ; Treatment Outcome ; Catheter Ablation

Objective: To investigate the feature and treatment of atrial tachycardia (AT) originated from right atrial appendage (RAA) in children. Methods: The data of 42 children with AT originated from RAA, who were admitted the First Hospital of Tsinghua University from January 2010 to September 2022 were analyzed retrospectively.The clinical characteristics, treatment and efficacy were analyzed. The children were divided into tachycardia cardiomyopathy group and normal cardiac function group. The differences in the ablation age and the heart rate during AT between two groups were compared by independent sample t-test. Results: Among 42 children, there were 20 males and 22 females. The age of onset was 2.7 (0.6, 5.1) years. Their age at radiofrequency ablation was (6.5±3.6) years, and the weight was (23.4±10.0) kg. Thirty-two children (76%) had sustained AT. The incidence of tachycardia cardiomyopathy was 43% (18/42). Compared to that of the normal cardiac function group, the ablation age and the heart rate at atrial tachycardia of the tachycardia cardiomyopathy group were higher ((8.1±3.8) vs. (5.3±3.1) years, t=-2.63, P=0.012; (173±41) vs. (150±30) beats per minute, t=-2.05, P=0.047. Thirty-eight children (90%) responded poorly to two or more antiarrhythmic drugs. The immediate success rate of radiofrequency ablation (RFCA) was 57% (24/42), and the AT recurrence rate was 17% (4/24). Twenty-two children underwent RAA resection, and their AT were all converted to sinus rhythm after the surgery. During the RAA resection, 10 cases of right atrial appendage aneurysm were found, 9/18 of which failed the RFCA. Conclusions: The AT originated from the RAA in children tend to present with sustained AT, respond poorly to antiarrhythmic drugs, and has a low success rate of RFCA as well as high recurrence rate. Resection of the RAA is a safe and effective complementary treatment.
Male ; Female ; Humans ; Child ; Atrial Appendage/surgery* ; Anti-Arrhythmia Agents/therapeutic use* ; Retrospective Studies ; Catheter Ablation ; Tachycardia/surgery* ; Treatment Outcome ; Cardiomyopathies

Objective: To investigate the acute and long-term outcome of catheter ablation for the treatment of ventricular tachycardia (VT) in patients with arrhythmogenic left ventricular cardiomyopathy (ALVC). Methods: This retrospective, cross-sectional study enrolled ALVC patients undergoing radiofrequency ablation for the treatment of VT at the First Affiliated Hospital of Nanjing Medical University from January 2011 to December 2018 and collected their clinical characteristics and intraoperative electrophysiological examination. Patients were followed up every 6 months after radiofrequency ablation until August 2021. Echocardiographic results and VT recurrence post radiofrequency ablation were analysed. Results: Totally 12 patients were enrolled (mean age: (42±15) years, 11 males(11/12)). The mean of left ventricular end diastolic diameter (LVDd) and left ventricular ejection fraction (LVEF) were (51±5)mm and (65±5)%, respectively. Twelve VTs were induced in 10 patients during the electrophysiological study, and the mean tachycardia cycle length was (293±65) ms. Three-dimensional substrate mapping revealed the diseased area at endocardial site in one patient, at epicardial sites in the other 11 patients (involved endocardial sites in 2 cases) with the basal part near the mitral annulus being the predilection for the substrate (10/11). After the catheter ablation at the endocardial and epicardial sites respectively, the complete procedure endpoint was achieved in all patients (VT cannot be induced post ablation). The median follow-up time was 65 (25, 123) months. One patient was lost to follow-up, and the other 11 patients survived without VT. No significant cardiac function deterioration was detected by the echocardiographic examination ((51±5)mm vs. (52±5)mm, P>0.05 for LVDd, (65±5)% vs. (60±6)%, P>0.05 for LVEF) at the end of follow-up. Conclusion: After radiofrequency ablation, the complete procedure endpoint is achieved in ALVC patients, and the catheter ablation provides long-term ventricular tachycardia control during the long-term follow-up.
Adult ; Cardiomyopathies ; Catheter Ablation ; Cross-Sectional Studies ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pericardium/surgery* ; Recurrence ; Retrospective Studies ; Stroke Volume ; Tachycardia, Ventricular/surgery* ; Treatment Outcome ; Ventricular Function, Left

BACKGROUND: Because many cosmetic surgery clinics are not adequately equipped to handle emergent conditions, patients often come to a university hospital when problems occur during or after cosmetic surgery. However, few in-depth studies have been conducted of this issue. Therefore, we investigated emergency department visits due to complications associated with cosmetic surgery. METHODS: A retrospective chart review was conducted of 38 patients who visited the emergency department of the authors' institution due to complications associated with cosmetic surgery from July 2014 to June 2017. RESULTS: There were more women than men (30 women vs. 8 men). Their mean age was 32.4 years (range, 19–57 years). Upon presentation to the emergency department, patients' vital signs and mental status were usually normal (27 normal vs. 11 abnormal). The types of surgery included blepharoplasty, rhinoplasty, malar/orthognathic surgery, mammaplasty, liposuction, fat grafting, and filler and botulinum toxin injections. Most patients required hospitalization (26 admitted vs. 12 discharged). Eight of the hospitalized patients required intensive care unit care, of whom two died and three experienced brain death or had permanent neurologic sequelae. CONCLUSIONS: The complications were usually minor problems, despite the need for hospitalization, but some complications were life-threatening. We recommend close monitoring and maintaining an adequate injection capacity for intravenous sedative anesthesia. When any symptom or sign of a complication occurs, it is best to transfer the patient to a university hospital as soon as possible. Taking a careful medical history is always needed, even for minor procedures.
Anesthesia ; Blepharoplasty ; Botulinum Toxins ; Brain Death ; Cardiomyopathies ; Emergencies ; Emergency Service, Hospital ; Epinephrine ; Female ; Hospitalization ; Humans ; Intensive Care Units ; Lipectomy ; Male ; Mammaplasty ; Retrospective Studies ; Rhinoplasty ; Surgery, Plastic ; Transplants ; Vital Signs

We report the rare case of a patient with advanced renal cell carcinoma (RCC) who initially presented to the hospital with symptoms of cardiac failure. Preoperative cardiac studies did not reveal any underlying ischemia. After resection of a large 14-cm left renal tumor, cardiac function was noted to improve dramatically. We discuss this case of concomitant RCC and nonischemic cardiomyopathy.
Asian Continental Ancestry Group ; Carcinoma, Renal Cell/*diagnosis/surgery ; Cardiomyopathies/*diagnosis ; Female ; Heart Failure/*etiology ; Humans ; Middle Aged ; Paraneoplastic Syndromes/complications ; Thalassemia/complications

Propofol is an intravenous hypnotic agent that is generally used for sedation in the intensive care unit and for induction of anesthesia during minimally invasive surgery, endoscopy, and plastic surgery in local clinics. Low blood pressure and transient apnea might occur under propofol sedation, whereas stress-induced cardiomyopathy is a very rare complication. We herein describe a case involving a 25-year-old woman without cardiovascular risk factors who developed stress-induced cardiomyopathy after propofol injection for anesthesia and was treated with conservative treatment. This case reminds us that clinicians should consider the possible occurrence of stress-induced cardiomyopathy after anesthesia using propofol, even in patients without cardiovascular risk factors.
Adult ; Anesthesia* ; Apnea ; Cardiomyopathies* ; Endoscopy ; Female ; Humans ; Hypotension ; Intensive Care Units ; Propofol* ; Risk Factors ; Surgery, Plastic ; Surgical Procedures, Minimally Invasive

We present a case of an open surgical repair of an infraumbilical hernia, which was performed on a 45-year-old man categorised as American Society of Anesthesiologists class 4; he weighed 107 kg, and had a body mass index of 34.2 kg/m2 and nonischaemic cardiomyopathy (left ventricular ejection fraction of 20%). Due to the patient's significant perioperative risks, the surgery was performed with the patient under ultrasonography-guided bilateral rectus sheath blocks; 15 mL of 1% lignocaine and 10 mL of 0.5% bupivacaine were deposited in the space between the rectus abdominis and posterior rectus sheath. The patient tolerated the surgery with minimal further sedation and additional analgesia. Rectus sheath block is a useful regional technique for periumbilical surgery, allowing surgery in highrisk patients while avoiding general anaesthesia and central neuraxial blockade. The use of real-time ultrasonographic guidance may reduce risks of peritoneal puncture, bleeding and visceral injury, while potentially increasing the rate of success.
Analgesia ; Anesthesia ; Anesthesiology ; Body Mass Index ; Bupivacaine ; chemistry ; Cardiomyopathies ; Hemodynamics ; Hernia, Umbilical ; surgery ; Herniorrhaphy ; methods ; Humans ; Lidocaine ; chemistry ; Male ; Middle Aged ; Nerve Block ; methods ; Rectus Abdominis ; pathology ; Treatment Outcome ; Ultrasonography

We report a case of intraocular lymphoma in a 65-year-old man, 15 months after cardiac transplantation. On Magnetic Resonance (MR) images, the iris and the anterior chamber of the right eye were found to be involved with an enhancing soft-tissue lesion. To our knowledge, this is the first case of post-transplantation intraocular lymphoma evaluated with MR imaging.
Cardiomyopathies/surgery ; Diabetes Mellitus, Type 2/complications ; Diagnosis, Differential ; Eye Neoplasms/*diagnosis ; Fatal Outcome ; Heart Transplantation ; Humans ; Lymphoma/*diagnosis ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged

OBJECTIVE: To estimate the therapeutic effect and safety of intra-aortic balloon pumps (IABP) in patients with serious cardiovascular diseases. METHODS: We retrospectively analyzed the clinical data of 68 patients with serious cardiovascular diseases, who were enrolled in Hunan Provincial People's Hospital between 2009 and 2011. All patients received IABP support. The systolic blood pressure, diastolic blood pressure,heart rate, N-terminal precursor of brain natriuretic peptide (NT-proBNP), and renal function of all patients were determined before and after the IABP. Cardiac events and mortality were observed after IABP support. RESULTS: The disease in 51 patients improved after IABP support. The systolic blood pressure, diastolic blood pressure,heart rate, and NT-proBNP were significantly lower than those before the IABP. Thirty-seven patients with acute myocardial infarction successfully completed percutaneous coronary intervention surgery after the IABP support. Five patients had IABP-related complications, but no serious complication occurred. CONCLUSION IABP is an effective and safe procedure for critical cardiovascular patients. IABP should be applied early for the patients with appropriate indications.
Aged ; Cardiomyopathies ; surgery ; therapy ; Critical Illness ; Female ; Humans ; Intra-Aortic Balloon Pumping ; methods ; Male ; Middle Aged ; Myocardial Infarction ; surgery ; therapy ; Retrospective Studies

Heart transplantation is a standard treatment for end-stage heart disease. Pediatric heart transplantation, however, is not frequently performed due to the shortage of pediatric heart donors. This is the first report of pediatric heart transplantation in Korea. Our retrospective study included 37 patients younger than 18 yr of age who underwent heart transplantation at Asan Medical Center between August 1997 and April 2009. Preoperative diagnosis was either cardiomyopathy (n = 29, 78.3%) or congenital heart disease (n = 8, 22.7%). Mean follow up period was 56.9 +/- 44.6 months. There were no early death, but 7 late deaths (7/37, 18.9%) due to rejection after 11, 15, 41 months (n = 3), infection after 5, 8, 10 months (n = 3), suspicious ventricular arrhythmia after 50 months (n = 1). There was no significant risk factor for survival. There were 25 rejections (25/37, 67.6%); less than grade II occurred in 17 patients (17/25, 68%) and more than grade II occurred in 8 patients (8/25, 32%). Actuarial 1, 5, and 10 yr survival was 88.6%, 76.8%, and 76.8%. Our midterm survival of pediatric heart transplantation showed excellent results. We hope this result could be an encouraging message to do more pediatric heart transplantation in Korean society.
Adolescent ; Arrhythmias, Cardiac/mortality ; Cardiomyopathies/surgery ; Child ; Child, Preschool ; Female ; Graft Rejection/mortality ; Heart Defects, Congenital/surgery ; *Heart Transplantation ; Humans ; Immunosuppression/methods ; Infant ; Infection/mortality ; Male ; Postoperative Complications ; Republic of Korea ; Retrospective Studies ; Tissue Donors ; Treatment Outcome